The Advantages and Disadvantages of Hair Loss Therapy

With approximately 70% of men and 40% of women affected by pattern baldness¹, a great deal of research has been invested into hair loss therapy. As a result, several options for treatment are now available from both topical and oral medication, surgical intervention and now the more futuristic sounding laser treatments. Moreover as fortunate as it is to have choice, that can sometimes make a tough decision even more difficult. Thus listed here are some considerations to keep in mind when electing for hair loss therapy.

Medications

There are two FDA-approved medications which have been shown to promote hair growth and prevent any further hair loss. Minoxidil is available as a topical solution while finasteride is an oral pill.

Minoxidil

Advantages

• Minimal side effects
• Clinical research to support its effectiveness²

Disadvantages

• Time-consuming topical applications
• More effective in earlier stages of hair loss
• Continued application is required to maintain results, hair loss resumes once treatment is stopped

Finasteride

Advantages

• Easy to use
• Clinical research to support its effectiveness³ and may provide some of the best non-surgical results

Disadvantages

• Not recommended for women
• A prescription is required
• More effective in earlier stages of hair loss
• Currently under investigation for some serious sexual side-effects that have been reported in a small percentage of patients⁴
• Continued application is required to maintain results, hair loss resumes once treatment is stopped

Hair Transplant

Advantages

• Effective and long lasting
• Natural hair growth

Disadvantages

• More than one treatment may be necessary
• Surgical procedure
• Success depends on the skill of the surgeon
• Price limiting

Low Level Laser Therapy

Advantages

• Easy to use
• Absence of side effects

Disadvantages

• Efficacy may vary between individuals
• Believed to stimulate present hair follicles but not bring back those which have been lost

Taken together, the best plan of action for hair loss treatment will vary with each individual. In many cases, a combination of treatments may be the most beneficial. Most importantly, talk with your physician or hair restoration expert prior to starting any of these treatments.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Santos Z, Avci P, Hamblin MR. Drug discovery for alopecia: gone today, hair tomorrow. Expert Opin Drug Discov 2015;10:269–92.
2. Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed 2015;13:185–9.
3. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat 2014;25:156–61.
4. Perez-Mora N, Velasco C, Bermüdez F. Oral Finasteride Presents With Sexual-Unrelated Withdrawal in Long-Term Treated Androgenic Alopecia in Men. Skinmed 2015;13:179–83.

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Scarring alopecias Pt. 1: Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a rare condition that mostly affects post-menopausal women. The average age of onset is about 56 years, with cases occurring as young as 21 years.(1) FFA was first described in 1994 as a type of scarring alopecia, which destroys hair follicles and subsequently replaces them with scar tissue.(2) FFA is considered a type of lichen planopilaris (an inflammatory condition that causes patchy hair loss on the scalp) but others consider it as a new disease.(3) FFA presents as a receding hairline at the front and sides of the scalp that may progress above and beyond the ears.(4) The hair loss can be sudden and proceed rapidly or can occur slowly and subtly.(4) FFA has also been reported to stabilize spontaneously over time.(5) One of the most typical and earliest signs of FFA is a loss of eyebrow hair;(3) however, it may also be associated with a loss of body hair.(4)

The cause of FFA is currently unknown. There may be complex factors influencing whether or not someone develops FFA, such as genetics, immune response, and hormones. There are some studies showing familial cases of FFA.(3) Other studies have found that FFA is associated with autoimmune conditions such as lupus erythematous, vitiligo, and rheumatoid arthritis.(4) Another possibility is that FFA is caused by a decrease in estrogen levels after menopause or after a hysterectomy.(1)

There is very little research examining possible treatments for FFA and the research that exists has many limitations. Based on a review of all treatments reportedly used for FFA, Harries and Messenger concluded that intralesional triamcinolone acetonide 20mg/mL (a corticosteroid) given every three months to the frontal hairline may be the most effective treatment available to date.(6) However, no randomized controlled trials have been conducted yet. Other treatment regimens that have been given to patients with FFA include: finasteride, dutasteride, minoxidil, corticosteroids (topical, systemic), hydroxychloroquine, tetracycline, topical retinoid, ketoconazole shampoo, and biotin.(5) Few papers have reported attempts at hair transplantation for FFA, with results suggesting that the transplanted hairs may do well initially but may disappear 2-4 years after the transplant.(7)  Treatment for FFA and scarring alopecias focus on stopping hair loss progression and alleviating disease symptoms. Treatments cannot regenerate hair from scarred areas.(7)

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, Arias-Santiago S, Rodrigues-Barata AR, Garnacho-Saucedo G, et al. Frontal fibrosing alopecia: A multicenter review of 355 patients. J Am Acad Dermatol. 2014 Apr;70(4):670–8.
2. Kossard S. Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution. Arch Dermatol. 1994 Jun;130(6):770–4.
3. Navarro-Belmonte MR, Navarro-López V, Ramírez-Boscà A, Martínez-Andrés MA, Molina-Gil C, González-Nebreda M, et al. Case series of familial frontal fibrosing alopecia and a review of the literature. J Cosmet Dermatol. 2015 Mar;14(1):64–9.
4. Banka N, Mubki T, Bunagan MJK, McElwee K, Shapiro J. Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up. Int J Dermatol. 2014 Nov;53(11):1324–30.
5. Rácz E, Gho C, Moorman PW, Noordhoek Hegt V, Neumann H a. M. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol JEADV. 2013 Dec;27(12):1461–70.
6. Harries MJ, Messenger A. Treatment of frontal fibrosing alopecia and lichen planopilaris. J Eur Acad Dermatol Venereol JEADV. 2014 Oct;28(10):1404–5.
7. Jiménez F, Poblet E. Is hair transplantation indicated in frontal fibrosing alopecia? The results of test grafting in three patients. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2013 Jul;39(7):1115–8.

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Pumpkin seed oil for treatment of androgenetic alopecia

Androgenetic alopecia (AGA) is a common form of hair loss in men, with an increased risk of hair loss for men over the age of 40 (1). With AGA, hair becomes thinner over time as hair follicles miniaturize and spend less time in the active growth phase (anagen), and more time in the resting phase (telogen) (2). Dihdrotestoderone (DHT) plays a large role in the miniaturization of hair follicles, leading to thinning and further loss of hair (3).

Currently, two United States Food and Drug Administration (US FDA) approved drugs exist for the treatment of AGA; finasteride (Propecia®) and minoxidil (Rogaine®). Finasteride works through inhibition of DHT (4), whereas minoxidil works by increasing blood flow to hair follicles (5). Both finasteride and minoxidil are effective therapeutic options for the treatment of AGA; however, they are associated with unwanted side effects (6–8). Due to the risk of adverse side effects, some patients are drawn to alternative treatments, such as natural plant oils.

A recent study was performed to test the efficacy of pumpkin seed oil for the treatment of AGA (9). Men ages 20-65 with mild to moderate AGA were enrolled to receive 400 mg of pumpkin seed oil (Octa Sabal Plus®) capsules per day. After 24 weeks of treatment, the pumpkin seed oil treatment group had a 40% average increase in hair counts from baseline, whereas the placebo treatment group had an increase of 10%. Results from investigators blinded to the treatment groups suggest pumpkin seed oil is more effective compared to placebo, as 44.1% of the pumpkin seed oil group were rated as improved, whereas only 7.7% of the placebo group improved. Although this data was statistically significant, there were no units of measurement shown (ex. hair count per mm²) so extrapolating to clinical significance is difficult. This was also a very small study, with only 37 patients receiving the pumpkin seed oil capsules and 39 receiving placebo.

Side effects were mild, and included body itching (2 participants) and abdominal discomfort (1 participant).

Always check with your physician before starting a new treatment regimen, and talk to your hair loss specialist to determine which form of treatment would work best for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

1. Hoffmann R. Male androgenetic alopecia. Clin Exp Dermatol. 2002 Jul;27(5):373–82.
2. Semalty M, Semalty A, Joshi GP, Rawat MSM. Hair growth and rejuvenation: an overview. J Dermatol Treat. 2011 Jun;22(3):123–32.
3. Kaufman KD. Androgens and alopecia. Mol Cell Endocrinol. 2002 Dec 30;198(1-2):89–95.
4. Roberts JL, Fiedler V, Imperato-McGinley J, Whiting D, Olsen E, Shupack J, et al. Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999 Oct;41(4):555–63.
5. Sica DA. Minoxidil: An Underused Vasodilator for Resistant or Severe Hypertension. J Clin Hypertens. 2004 May;6(5):283–7.
6. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578–89.
7. Ali AK, Heran BS, Etminan M. Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study. Pharmacotherapy. 2015 Jul;35(7):687–95.
8. Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003 Jul 1;68(1):93–102.
9. Cho YH, Lee SY, Jeong DW, Choi EJ, Kim YJ, Lee JG, et al. Effect of Pumpkin Seed Oil on Hair Growth in Men with Androgenetic Alopecia: A Randomized, Double-Blind, Placebo-Controlled Trial. Evid Based Complement Alternat Med. 2014;2014:1–7.

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Restoring hair in facial and scalp burns

Experiencing a facial and/or scalp burn involves a long journey of healing that can result in physical deformities that affect facial expressions and sense of identity, including self-esteem.(1) In the affected areas, the hair follicles are often destroyed and replaced with scar tissue. Hair restoration, including follicular unit transplantation (FUT) and follicular unit extraction (FUE) can be used to restore hair to burn sites. One of the first hair restoration treatments was actually performed on burn victims in 1939.(2) However, hair restoration can be complicated as some burn victims may have limited hair available in the donor area to transplant, especially if the donor area was also burned.(3) Recently, a method called partial FUE has been discussed to address this issue.(3) Although this method is not in widespread use, it is an interesting concept that we may see more of in the future.

Partial FUE works by removing a partial follicular unit from the donor area so that both the donor site and the extracted partial follicle retain follicular stem cells.(3) Previous research has found that both the distal and proximal part of the hair follicle contains stem cells that can generate hair growth.(4,5) Retaining stem cells allows two hair follicles to be generated from one. This technique would allow the donor area to continue producing hair that could then be used for future treatments. Although this technique sounds promising, it can be challenging as scar tissue behaves differently from normal skin and the procedure is labour-intensive, taking up to a full day.(3) The authors also caution that more experience with partial FUE in burn victims is needed to better understand the limitations and future potential of this technique.(3) Until then, hair restoration using FUT or FUE may be possible.

Hair restoration can be particularly important for people who have experienced burns in order to improve their well-being and quality of life. If you are considering hair restoration to address hair loss from burns, please contact a hair transplant surgeon.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Rivlin E, Faragher EB. The psychological effects of sex, age at burn, stage of adolescence, intelligence, position and degree of burn in thermally injured adolescents: Part 2. Dev Neurorehabilitation. 2007 Jun;10(2):173–82.
2. Jimenez F, Shiell RC. The Okuda papers: an extraordinary–but unfortunately unrecognized–piece of work that could have changed the history of hair transplantation. Exp Dermatol. 2015 Mar;24(3):185–6.
3. Gho CG, Neumann HAM. Improved hair restoration method for burns. Burns J Int Soc Burn Inj. 2011 May;37(3):427–33.
4. Kim JC, Choi YC. Regrowth of grafted human scalp hair after removal of the bulb. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 1995 Apr;21(4):312–3.
5. Reynolds AJ, Lawrence C, Cserhalmi-Friedman PB, Christiano AM, Jahoda CAB. Trans-gender induction of hair follicles. Nature. 1999 Nov 4;402(6757):33–4.

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Extreme Shedding Part 2: Triggers and Catalysts

In my last post I described the relatively common phenomenon of telogen effluvium, where growth cycles of the hair follicles synchronize, resulting in extreme shedding and an abundance of clogged shower drains. The sheer volume of hair loss can be frightening and upsetting, as well as tough on your vacuum cleaner. Fortunately, as difficult as the process is, the hair does grow back.

So what causes telogen effluvium and how do we avoid it completely? As mentioned last time, pregnancy hormones are a known instigator, but there are also many other suspected triggers. Stress, illness, pharmaceuticals, our own hair growth patterns and seasonal changes can all impact shedding.

Stress, illness and pharmaceuticals have all been suspected causes of “immediate anagen release”¹. What happens is a large number of hair follicles which had been actively growing suddenly revert to a resting phase. It takes about 2 or 3 months, but all of that hair falls out at once.

Pharmaceuticals can also cause “immediate telogen release”². Almost the reverse of immediate anagen release, starting a new medication such as minoxidil can encourage new hair growth. Non-growing hairs originating from follicles in a resting phase are released to make way for new hair growth as the follicles switch to an active growing phase.

Chronic telogen effluvium combined with an inability to grow longer hair is normally caused by “short anagen syndrome”³. In this case, for whatever reason, the growth phase of the hair cycle is consistently short. That means the hair follicles are entering the resting and shedding phases relatively more often than usual, therefore shedding is happening more often than usual.

Although it’s most often associated with animals, there are also reports of seasonal shedding in people¹. If you have ever shed your winter or summer hairstyle, it may have been a result of “delayed telogen release”. The hair follicles remain in the resting phase for extended periods of time before returning to the growing phase.

As mentioned above, as frustrating (or scary) as it is at the time of shedding, in the case of telogen effluvium, the hair does grow back. A disruption in the hair cycle occurs but it does not result in permanent hair loss as is the case for pattern hair loss and similar conditions. Additionally, see your hair loss specialist for any further questions.

Article by: Dr. J.L. Carviel PhD, Mediprobe Research Inc.

References

1. Headington JT. Telogen Effluvium: New Concepts and Review. Arch Dermatol 1993;129:356.
2. Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol 2013;79:591–603.
3. Gilmore S, Sinclair R. Chronic telogen effluvium is due to a reduction in the variance of anagen duration. Australas J Dermatol 2010;51:163–7.

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Topical rosemary oil for treatment of androgenetic alopecia

There are currently only two drugs with United States Food and Drug Administration (US FDA) approval for the treatment of androgenetic alopecia; topical minoxidil (Rogaine®), and oral finasteride (Propecia®). Although these drugs have proven to be effective at reversing hair loss, they are associated with a variety of side effects (mentioned in previous blogs on finasteride and minoxidil) (1–3). Because of the risk of side effects with current medications, investigation of other therapies for androgenetic alopecia have been a popular area of interest.

A recent clinical trial was conducted comparing the efficacy of rosemary oil versus minoxidil 2% in the treatment of androgenetic alopecia (4). Participants were males aged 18-49 years, with androgenetic alopecia. Participants applied one milliliter of solution (minoxidil 2% or rosemary oil lotion containing 3.7 mg 1,8-cineole per mL) to the frontoparietal and crown areas of the scalp twice daily for six months.

Results were measured at 3 months and 6 months after the onset of treatment. Results indicate a significant increase in hair count after 6 months in both the rosemary oil and minoxidil 2% treatment groups. Although the numerical increases in hair count were statistically significant, this may not relate back to clinical significance. Baseline hair counts for rosemary and minoxidil 2% were 122.8 and 138.4, respectively (size of area not indicated). After 6 months there was an increase of 6.8 hairs for the rosemary group, and 2.3 for the minoxidil 2% group. Keep in mind that even though there was only a small increase in hair count number, it was not a decrease. This study suggests that both rosemary oil and minoxidil 2% solution are effective at inhibiting/slowing hair loss.

Side effects were mild and included dry hair, greasy hair, dandruff, and scalp itching.

Always make sure to consult your hair loss specialist before trying a new treatment option, and make sure to discuss potential treatment outcomes and side effects.

Article by: Dr. C.D. Studholme PhD,  Mediprobe Research Inc.

1. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578–89.
2. Ali AK, Heran BS, Etminan M. Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study. Pharmacotherapy. 2015 Jul;35(7):687–95.
3. Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003 Jul 1;68(1):93–102.
4. Panahi Y, Taghizadeh M, Marzony ET, Sahebkar A. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. Skinmed. 2015 Feb;13(1):15–21.

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Trichotillomania (hair pulling disorder)

Trichotillomania (TTM) is a behavioural (impulse control) disorder that involves repetitive hair pulling, resulting in hair loss.(1) TTM most often begins in the preadolescent-adolescent years with the mean age of onset being 9-13 years.(2) In this age group, it is more common among females (70-93%).(2) However, TTM can also occur in preschool age children where it may appear similar to other habits such as nail biting or thumb sucking. These young children are often unaware that they are pulling out their hair, which can be triggered by stressful situations such as a new sibling, lack of affection, or infections.(2) In preschool age children, TTM can usually be seen equally in males and females with most children growing out of it.(2) When TTM onset occurs in adulthood, it may be secondary to an underlying psychiatric condition and is generally a more chronic condition.(3) Interestingly, alopecia areata can also lead to TTM as a result of itchiness and pain that causes scratching of the scalp and hair pulling.(2) People with TTM may also pull out hair from their eyebrows, eyelashes, face, arms, legs, and pubic area (3) and demonstrate other habits such as nail biting, skin picking, and lip biting.(2)

Subconscious pulling vs. conscious pulling

About 75% of adults with TTM had times when they did not realize they were pulling out their hair.(2) Subconscious hair pulling may occur (especially in children) when reading, studying, or watching television. Conscious hair pulling usually occurs with a specific ritual (e.g. pulling out white hairs or hairs with different textures).(2) People with conscious TTM may pull the hair until it “feels right” or in response to a sensation in the area (e.g. feels like there is tension that is relieved once the hair is pulled).(2) There may also be rituals with the hair after it is pulled such as chewing, licking, rubbing along the lips, biting the hair bulb, and eating the hair.(2)

Clinical signs

Diagnosis of TTM is generally done using trichoscopy, a handheld microscope to examine the scalp.(3) Some signs of TTM include unusual patterns of patchy hair loss with broken hairs of different lengths and reduced hair density.(1,3) A typical pattern called the Friar Tuck sign often occurs when hair pulling involves the crown of the head with the periphery of the hair left unaffected. Diagnosis can also be made using a microscope if there are findings of increased catagen and telogen hairs without inflammation. The chronic hair pulling induces catagen phase and as the hair growth cycle continues, there are more telogen hairs.(2)

Treatment

Most people with TTM have tried to stop at one point or another. Treatment may require addressing an underlying psychological issue, which may also include the use of pharmacological interventions such as anti-depressants.(2) However, the most successful form of treatment is cognitive behavioural therapy (CBT), or behaviour modification, including habit reversal therapy.(2) This includes awareness training to become alert to the triggers and then modifying the behaviour.

For more information and access to support groups, please visit the Trichotillomania Learning Center website.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Yorulmaz A, Artuz F, Erden O. A case of trichotillomania with recently defined trichoscopic findings. Int J Trichology. 2014 Apr;6(2):77–9.
2. Sah DE, Koo J, Price VH. Trichotillomania. Dermatol Ther. 2008 Feb;21(1):13–21.
3. Rakowska A, Slowinska M, Olszewska M, Rudnicka L. New trichoscopy findings in trichotillomania: flame hairs, V-sign, hook hairs, hair powder, tulip hairs. Acta Derm Venereol. 2014 May;94(3):303–6.

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Which non-surgical treatment for androgenetic alopecia is the best?

Androgenetic alopecia is also known as male pattern baldness or female pattern hair loss. This is the most common type of hair loss in both men and women. Any hair loss can be a difficult situation to handle and navigating the treatment landscape can be confusing. An internet search for “treatment for hair loss” returns over 50 million entries! This post is a brief introduction to the approved and safe non-surgical methods for treating hair loss in men and women.

Rogaine® (generic name: minoxidil) is the only FDA- and Health Canada approved medication for female hair loss, while finasteride (Propecia®) and minoxidil are approved for use in men. Low level laser therapy is cleared by the FDA and Health Canada as hair loss treatment for both men and women.

Minoxidil is a topical medication that comes as a solution or foam. The 2% solution is applied twice daily and the 5% foam is applied once daily. While both show similar results, using the foam may be easier, with less disruption to daily grooming routines, and less itching and dandruff as compared to solution.¹ In clinical trials, both formulations, 2% solution and 5% foam, resulted in significantly higher hair counts after 3-6 months.

Finasteride is a well-known treatment for male pattern baldness and has been used for nearly 25 years. It is only approved for men, as it is works by decreasing the levels of androgen hormones (dihydrotestosterone). In clinical trials, patients reported improvement in hair loss and hair appearance. Significant increases in hair counts were seen after 1 and 2 years of treatment with finasteride, while those patients in the control group continued to experience hair loss.^2,3

Low level laser therapy (LLLT) is non-invasive, with devices in the shape of helmets and combs. LLLT is safe and can be used in-office or in the privacy of your home. This treatment option can be attractive to people who do not wish to take medications. Clinical trials have shown that LLLT is effective, with increases in hair counts after 6 months of use similar to that seen with medications.^4–6

Research has shown that the medications discussed above and laser therapy all show benefits to patients with hair loss, with an increase in hair count occurring with at least 3 months of minoxidil use and at least 6 months of finasteride or laser therapy. Individual results may vary, and some patients in clinical studies did not experience very much hair growth. To answer the question posed in the title is going to depend on the extent of your hair loss and what your treatment goals are. In all cases, consultation with a hair loss specialist will be necessary to determine the most appropriate treatment option for you.

Article written by: Dr. K.A. Foley, Mediprobe Research Inc.

References

1. Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermatol 2011;65:1126–34.e2.
2. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 1998;39:578–89.
3. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol 1999;40:930–7.
4. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. Am J Clin Dermatol 2014;15:115–27.
5. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini RP, Fernandez-Obregon A, Kazmirek ER. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013;45:487–95.
6. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek ER, Sklar JA. The growth of human scalp hair in females using visible red light laser and LED sources. Lasers Surg Med 2014;46:601–7.

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Extreme Shedding: Could I be going bald?

With the exception of the obvious excitement of the arrival of a new baby, there wasn’t much that I enjoyed about pregnancy. One symptom that I did appreciate was that my hair seemed to be getting thicker and longer. I couldn’t see my toes for months but at least I had a great pony tail. Until very suddenly one day I didn’t. It was after my princess was born and around the time that I began weening. After shampooing one evening all of my beautiful pregnancy hair fell out in clumps. All at once.

Thankfully all it took was a second pregnancy to regain my long hair. Princess number two had a much more difficult time transitioning to solid food which led to a much longer period of nursing the second time around. This time I was prepared for what was to come. Surprisingly though, I did not dramatically lose all my hair in one evening and even a more gradual hair loss was not right away. But when I did start losing enough hair to build a new pet Chihuahua every day, instead of worrying that I was very quickly going bald, I was equipped with a label for what I was experiencing.

Telogen effluvium is a condition whereby some people lose hundreds of hairs in a single day (1). Aside from the extreme shedding, people are normally in good health (1). The condition may become chronic, with periods of remission followed by relapses (1). Common symptoms sometimes include loss of 100 – 400 strands of hair per day with a noticeable reduction in pony tail size (2). Interestingly, despite the obvious hair loss, total hair density remains stable (2). So how is this possible?

Hair grows in cycles. At some points in time, hair is actively growing. At other times the hair follicle enters a resting period. Eventually the hair falls out which allows the follicle to return to its active growing phase. Unlike certain animals that shed seasonally, the hair cycle in people is asynchronized. What that means is that at any given point in time, you will find different hair follicles at a different stage in the hair cycle. Thus we are always losing some amount of hair but always actively growing hair as well. During telogen effluvium, the individual hair follicles become much more synchronized, resulting in a large loss of hair at the same time. Fortunately though, those hair follicles also return to the growing phase which is how the steady hair density is maintained.

There are several different ways in which the hair follicles can become synchronized and there are even more catalysts suspected to trigger these events. Some of these will be addressed in subsequent blogs. For pregnancy however, “delayed anagen release” has been reported. Anagen is the medical term for the growth phase of the hair cycle. Pregnancy hormones encourage the hair follicles to remain in the growing phase, leading to simultaneous heavy shedding 3-4 months postpartum when those hormones subside (3,4). A similar effect is sometimes observed after discontinuation of contraceptive pills (3,5).

Putting a label on what I was experiencing helped confirm that I wasn’t imagining anything, as well as reduced my worry that all the tumble weeds rolling around my bathroom and clogging my vacuum cleaner would lead to baldness. If you are concerned, your hair loss expert can help to differentiate telogen effluvium from other common hair loss conditions such as female pattern baldness and alopecia areata.

References

1. Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol. 2013 Oct;79(5):591–603.
2. Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am Acad Dermatol. 2005 Feb;52(2 Suppl 1):12–6.
3. Dawber RP, Connor BL. Pregnancy, hair loss, and the pill. Br Med J. 1971 Oct 23;4(5781):234.
4. Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol. 2005;6(3):165–73.
5. Griffiths WA. Diffuse hair loss and oral contraceptives. Br J Dermatol. 1973 Jan;88(1):31–6.

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History of hair transplantation

There are reports that the first hair transplant was performed in Germany in 1822 by a medical student named Diffenbach and their professor, Dr. Dom Unger.(1) They reportedly transplanted hair in both animals and humans from one area of the scalp to another; however, their technique did not seem to catch on. Hair transplantation is now recognized to have first developed in Japan in the 1930s through the work of Dr. Okuda.(2) Dr. Okuda used a punch technique to remove sections of hair that were then transplanted into smaller punches, where they were found to continue producing hair. Their technique was mainly performed in patients who had hair loss due to scarring from trauma. In 1943, Dr. Okuda’s technique was refined by Dr. Tamura who used smaller grafts of 1-3 hairs.(1) Because of Japan’s role in World War II, Dr. Okuda and Dr. Tamura’s progress in the field of hair restoration remained unknown outside of Japan for many years.

About 20 years later, hair transplantation was rediscovered in the United States by Dr. Orentreich.(3) The technique described in the influential 1959 paper was very similar to the technique described earlier by Dr. Okuda. However, Dr. Orentreich performed the technique mainly on patients with androgenetic alopecia. Both of these techniques used large grafts (around 4 mm) that created an unnatural look. This paper was also particularly influential because it was the first to describe the concept of donor dominance and recipient dominance. Dr. Orentreich described donor dominance as occurring when the transplanted hair maintained its characteristics regardless of the recipient site whereas recipient dominance occurred when the transplanted hair took on the characteristics of the recipient site.(3)

Over time, hair transplantation techniques were improved to create a more natural look. In 1984, mini-grafting was introduced, which used smaller grafts taken from a strip on the back of the scalp. Mini-micro grafting was also used, which involved placing smaller grafts around a larger graft in the centre to create a more natural look. This technique replaced the plug technique described earlier until the 1990s when follicular unit transplantation (FUT) was introduced. FUT uses a large number of mini-micrografts in naturally occurring groups, also known as strip harvesting. This was the main hair transplantation technique used until the 2000s, when follicular unit extraction (FUE) was introduced. These advances in technique have dramatically improved the appearance of hair transplants, creating a natural look in patients seeking to address their hair loss.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. International Society of Hair Restoration Surgery. History of hair restoration [Internet]. [cited 2015 Dec 1]. Available from: http://www.ishrs.org/mediacenter/media-history.htm
2. Jimenez F, Shiell RC. The Okuda papers: an extraordinary–but unfortunately unrecognized–piece of work that could have changed the history of hair transplantation. Exp Dermatol. 2015 Mar;24(3):185–6.
3. Orentreich N. Autografts in Alopecias and Other Selected Dermatological Conditions. Ann N Y Acad Sci. 1959;83(3):463–79.

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Risk Factors for Developing Pattern Baldness

With a high prevalence of baldness in the population, it seems quite common, especially as we age, to be concerned over those stray hairs building up in your hair brush and shower drain. But how likely are these concerns to come to fruition?  It’s impossible to predict with 100% certainty but there are some contributing factors that can increase your odds of developing pattern baldness. Likewise there are some urban legends in current circulation which have turned out to have absolutely nothing to do with your hair growth potential.

Age

Age is probably one of the first things to come to mind when discussing hair loss and unsurprisingly, your risk of hair loss does in fact increase with age. By age 50 years, the likelihood of male pattern hair loss has increased by 20% from age 30 years (1).

Genetics

Male pattern baldness is heritable (3). It is triggered by hormones called androgens. Some people can be genetically pre-disposed to be sensitive to androgen levels in the scalp, leading to hair loss. A family history is not a guarantee however, as it is believed to be a complex disorder that involves multiple genes as well as environmental factors (4).

Race and Sex

Males are significantly more likely to be affected in comparison with females (5). Similarly there is a lower prevalence in both Asian and black populations (6–9).

Alcohol

Consumption of alcoholic beverages has been associated with male-pattern baldness (2).

Weight

A negative correlation with body weight and development of male pattern baldness has been reported(2). Specifically, less hair loss was observed in those with less weight gain in their younger years (2).

Occupational and Environmental Factors

Research following occupational groups has also revealed some contributing factors. Studies show that people involved with certain types of work were twice as likely to develop pattern hair loss. Investigators identified increased exposure to sunlight and obesity at a young age as the root cause (10).

Non-risk factors

According to current research, your acne or marital status will not affect your hairline. Additionally, although a host of other unrelated  issues with smoking have been suggested, it is not believed to lead to hair loss (2).

Remember, this list is composed of risk factors only.  Having any or all of them does not ensure hair loss. If you are concerned though, speak with a hair loss specialist to assess your individual situation.

Article by: Dr. J.L. Carviel  PhD, Mediprobe Research Inc.

References

1. HAMILTON JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951 Mar;53(3):708–28.
2. Severi G, Sinclair R, Hopper JL, English DR, McCredie MRE, Boyle P, et al. Androgenetic alopecia in men aged 40-69 years: prevalence and risk factors. Br J Dermatol. 2003 Dec;149(6):1207–13.
3. Birch MP, Messenger AG. Genetic factors predispose to balding and non-balding in men. Eur J Dermatol EJD. 2001 Aug;11(4):309–14.
4. Levy-Nissenbaum E, Bar-Natan M, Frydman M, Pras E. Confirmation of the association between male pattern baldness and the androgen receptor gene. Eur J Dermatol EJD. 2005 Oct;15(5):339–40.
5. Norwood O. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001;27(1):53–4.
6. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol. 2007 Nov;157(5):981–8.
7. Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types of androgenetic alopecia in Korean men and women. Br J Dermatol. 2001 Jul;145(1):95–9.
8. Tang PH, Chia HP, Cheong LL, Koh D. A community study of male androgenetic alopecia in Bishan, Singapore. Singapore Med J. 2000 May;41(5):202–5.
9. Su L-H, Chen TH-H. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. 2007 Nov;143(11):1401–6.
10. Su L-H, Chen H-H. Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population (KCIS no. 23). Arch Dermatol Res. 2011 Dec;303(10):753–61.

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The Hair Growth Cycle

Hair growth occurs from within the hair follicle in the skin. The hair follicle goes through a cycle of growth containing four main stages:

• Anagen – active growth
• Catagen – regression
• Telogen – rest
• Exogen – shedding

Each individual strand of hair is at a different stage of development in any one moment in time, making changes in these phases generally unnoticeable.

Anagen

During each anagen phase a completely new hair forms. Growth of the new hair shaft lasts on average three years, but can last up to 7 years. Men and women with androgenetic alopecia have a shortened anagen phase and smaller hair follicles (1), whereas those with hirsutism have a longer anagen phase and more hair growth (2). During anagen, hair color is generated from specialized pigment-producing cells (3). Once color production stops, the hair shaft has entered the catagen phase (4).

Catagen

During this phase the hair follicle shrinks and further growth of the hair is prevented. Catagen phase lasts a few weeks.

Telogen

The hair does not grow or shrink at this point; it is in a resting phase which lasts approximately 3 months.

Exogen

The hair that was resting will now fall out and make room for new hair to grow. This process occurs independently of new hair formation in the underlying hair follicle (5), as a new hair has likely already started forming. It usually takes some time before a new anagen phase hair emerges, and this period is referred to as the kenogen phase (6). Men and women with androgenetic alopecia have a longer and more frequent kenogen phase (6), resulting in less hair on their head.

Article by: Dr. C.D. Studholme Ph.D. , Mediprobe Research Inc.

1. Sinclair RD, Dawber RP. Androgenetic alopecia in men and women. Clin Dermatol. 2001 Apr;19(2):167–78.
2. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995–1007.
3. Passeron T, Mantoux F, Ortonne J-P. Genetic disorders of pigmentation. Clin Dermatol. 2005 Feb;23(1):56–67.
4. Slominski A, Paus R, Plonka P, Chakraborty A, Maurer M, Pruski D, et al. Melanogenesis during the anagen-catagen-telogen transformation of the murine hair cycle. J Invest Dermatol. 1994 Jun;102(6):862–9.
5. Piérard-Franchimont C, Piérard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatol Basel Switz. 2001;203(2):115–7.
6. Rebora A, Guarrera M. Kenogen. A new phase of the hair cycle? Dermatol Basel Switz. 2002;205(2):108–10.

Photo taken from http://www.depilarsystem.com/_downloads/hair_growth_US.pdf

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Clinical trials demonstrate effectiveness of low level laser therapy (LLLT) helmet device

Low level laser therapy (LLLT) uses red light to stimulate hair growth. Two recent clinical trials investigated the use of a home-use LLLT helmet device (iGrow helmet, Apira Science) in men¹ and women² with androgenetic alopecia. The bicycle-like apparatus was used in the home for 25 minutes, every other day for 16 weeks, totaling 60 treatments. Patients in the control group used an identical helmet, but with incandescent red lights. These clinical trials were double-blinded, meaning that patients and the doctor evaluating treatments did not know which device (LLLT or control red light) a person had used.

Forty one men completed the clinical trial, 22 in the LLLT group and 19 in the control group. Pictures of the scalp were taken before treatment (baseline) and after treatment, with the area of interest being the vertex area of the head where hair loss was occurring. At the end of treatment (16 weeks), the percent increase in hair counts from baseline was calculated for each person. LLLT produced an increase in hair counts of 35% as compared to the control treatment. An average increase of 30.4 hairs/cm² was observed in the LLLT group, compared to an average decrease of -0.11 hairs/cm² in the control group.

Forty two women completed the clinical trial, 24 in the LLLT group and 18 in the control group. The procedure was similar as above, with pictures taken before and after treatment. The area of interest was again the vertex area of the head and the percent increase in hair counts from baseline was calculated for each person. LLLT produced an increase in hair counts of 37% as compared to the control treatment. An average increase of 35.2 hairs/cm² was observed in the LLLT group, compared to an average increase of 8.39 hairs/cm² in the control group.

In both clinical trials, there were no adverse side effects reported. The LLLT helmet device was safe and effective in increasing hair growth in men and women with androgenetic alopecia. In men, there was an average increase in hair of 35% and in women, an average increase of 37%. These clinical trials, at 4 months, were shorter than other clinical trials that have been conducted. Depending on the individual, it may take up to 6 months before one can determine whether LLLT is effective.

References:

1. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini RP, Fernandez-Obregon A, Kazmirek ER. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013;45:487–95.
2. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek ER, Sklar JA. The growth of human scalp hair in females using visible red light laser and LED sources. Lasers Surg Med 2014;46:601–7.

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Facial Hair Restoration

Over the last couple of years, facial hair transplants (particularly beard transplants) have grown in popularity. Various media outlets have noticed this growing trend.(1) Facial hair restoration can be used to create natural appearing facial hair where hair is sparse or completely absent. This can include restoring hair to the eyebrows, beards, goatees, mustaches, and sideburns.(2) Hair may be sparse or absent due to genetics, prior laser hair removal or plucking, trauma, or previous cosmetic surgery.(2)

The principle behind facial hair restoration is the same as scalp hair restoration.(3)  The donor hair comes from either the back or sides of the scalp, depending on which location matches the facial hair the best. If the patient is bald, donor hair from the body (e.g. chest) may be used. Hairs are transplanted using either strip-follicular unit grafting or follicular unit extraction (FUE).(2) The number of grafts required can vary depending on the area being restored. For example, a mustache restoration may require 350-500 grafts whereas a full goatee can require 600-700 grafts.(4) The hairs are carefully placed at the correct angle and in the right direction to create a natural look. Overall, facial hair restoration generally takes about 2-8 hours to complete and is performed under local anesthesia.(4) The transplanted hair is permanent and can be shaved just like regular facial hair. If you are considering a facial hair transplant, please contact one of our qualified hair transplant surgeons for more information.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Dalal M. Beard transplants a growing trend [Internet]. 2014 [cited 2015 Nov 18]. Available from: http://www.cbc.ca/news/health/beard-transplants-a-growing-trend-1.2592967
2. Epstein J. Facial hair restoration: hair transplantation to eyebrows, beard, sideburns, and eyelashes. Facial Plast Surg Clin N Am. 2013 Aug;21(3):457–67.
3. Gandelman M, Epstein JS. Hair transplantation to the eyebrow, eyelashes, and other parts of the body. Facial Plast Surg Clin N Am. 2004 May;12(2):253–61.

4.         Facial Hair Transplant [Internet]. Foundation For Hair Restoration. [cited 2015 Nov 17]. Available from: http://www.foundhair.com/pages/facial-hairtransplant.shtml

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Use of Body and Beard Hair in Hair Restoration

One of the limiting factors in hair transplantation is the amount of donor hair that an individual has on the scalp. For patients with extensive hair loss scalp donor hairs may not provide sufficient coverage for all affected areas. Body hair transplantation has emerged as a new option for selected patients with poor donor scalp hair and good body hair.¹

Follicular unit extraction (FUE) makes it possible to extract the individual follicular units from the body and beard donor areas without strip excision and suturing. It is important to keep in mind that the characteristics of body and beard donor hair differ from scalp donor hairs in length, growth cycles, shaft diameter (calibre), curl, and colour, which do not change when the hair is transplanted to the scalp. Thus, proper planning is critical when using the different types of donor hair for transplanting.

Beard hair is a good option for donor hair due to its thicker caliber and the length that may be achieved after transplantation compared to hair from other areas of the body. Chest hair is also a good candidate for body donor hair as it has been shown to have the lowest transection rate (the potential for damage that can occur to the hair follicles during transplantation). Donor hair from the back, arms, and abdomen have also been used in hair transplants; however this hair is thinner and has been shown to have a higher transection rate.²

However, the use of body hair in hair restoration is still a relatively new concept, for which limitations and concerns still need to be addressed:

• The procedure is possible only in patients who have a good amount of body/beard hair.
• The procedure is performed by an extraction method which may produce small scars to the body donor area.
• Follicular unit extraction can be a slow and painstaking method. As such, the procedure requires a high degree of motivation from the patient as multiple sessions may be required to achieve desired results.
• Body hairs are usually found as 1 and 2 hair units, and hence the density and thereby results achieved may not be as impressive as with scalp hair.
• Body hairs are shorter in length and thinner, which means that transection rates will be higher than those of scalp donor hairs. While transection rates with scalp hairs are 5% or lower, the rate of transection with body hairs ranges from 13-32%.²

Article by: Dr. M. Cernea Ph.D., Mediprobe Research Inc.

References

1. Umar S. 2013. Use of body hair and beard hair in hair restoration. Facial Plast Surg Clin North Am.; 21(3):469-77.
2. Venkataram, M. 2013. Body Hair Transplantation: Case Report of Successful Outcome. J Cutan Aesthet Surg.; 6(2): 113–116.

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Treating Alopecia Areata with Platelet-Rich Plasma

Alopecia areata (AA) is an autoimmune condition which results in hair loss. It affects both women and men of all age groups and symptoms range from mild with only slight patches of hair loss typically of the scalp, to extreme, with loss of scalp and body hair including eyebrows and eyelashes.  Prognosis is also diverse with spontaneous remission observed in some cases and a completely unresponsive nature in others. Thus it is exciting to hear the recent report of an extreme case that resulted in successful treatment.

This past month the story of a 15-year-old boy who had lost 80% of his hair (including body hair) due to AA was reported. After five years with AA and undergoing multiple traditional treatments, platelet-rich plasma (PRP) therapy was finally able to restore the lost hair (1). With the post-treatment photographs featuring a full head of long hair, the results were impressive (1). PRP therapy is a relatively new treatment employed for multiple types of hair loss. Growth factors obtained from a small sample of the boy’s own blood were used to stimulate the new hair growth.

Two scientific studies lend some credibility to this case. A randomized, controlled trial concluded that PRP therapy led to significant growth and recommends further investigation into PRP as a safe and effective treatment option for AA (2). A second trial reported a lack of side-effects associated with the procedure and confirmed safety (3).

Overall, AA can be challenging to treat. This makes the introduction of innovative therapies such as PRP essential to improving upon the current options. Initial therapies are generally potent topical or intralesional corticosteroids. Please consult with your health care provider if you think that you may have this condition.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Vekris A, Zefeiratou D, Andriopoulou A, Tsiatoura A. Total Regrowth in Chronic Severe Alopecia Areata Treated with Platelet Rick Plasma: A Case Report and Literature Review. Hair Transpl Forum Int. 2015;(September/October):190–1.
2. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690–4.
3. Singh S. Role of platelet-rich plasma in chronic alopecia areata: Our centre experience. Indian J Plast Surg Off Publ Assoc Plast Surg India. 2015 Apr;48(1):57–9.

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What is low level laser (light) therapy (LLLT)?

Low level laser therapy, also known as low level light therapy (LLLT), uses red light to stimulate hair follicles to grow. Laser light therapy is used to treat many dermatological conditions, as well as wound healing and joint pain relief. Possible mechanisms of action include extension of the growth phase of hair follicles (anagen) or re-entry of resting hair follicles into the growth phase (telogen to anagen).^{1, 2} LLLT requires hair follicles to be present in the dermal (mid) and subcutis (deep) layers of the skin.

In office LLLT devices have more diodes/ LEDs and are more effective than the devices available for home use. When in-office treatment is not possible then there are devices that can be used at home or combined with in-office visits. Home use devices include laser helmets/ caps/ combs. The only devices cleared for home use by Health Canada are the iGrow Helmet (Apira Science) and the HairMax Laser Comb (Lexington).

Clinical research has demonstrated that the efficacy of LLLT therapy may be similar to that of the use of 5% minoxidil (Rogaine) and oral finasteride. However, individual results may vary. For optimal results the source of the light has to be close to the scalp. The effectiveness of LLLT likely depends on consistent use (3 times/week) for at least 6 months,^3–5 and as long as 12 months, depending on the individual’s response.

References:

1. Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med 2014;46:144–51.
2. Keene SA. Part 2: LLLT Devices, Medical Device Regulation, and Impact on Development. Hair Transpl Forum Int 2015;25:10–2.
3. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. Am J Clin Dermatol 2014;15:115–27.
4. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek ER, Sklar JA. The growth of human scalp hair in females using visible red light laser and LED sources. Lasers Surg Med 2014;46:601–7.
5. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini RP, Fernandez-Obregon A, Kazmirek ER. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013;45:487–95.

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Are You a Hair Transplant Candidate?

There are a few things you should take into consideration to determine if you are a good candidate for a hair transplant.^1,2

One of the most important factors to consider is expectations. If you are expecting to regain your adolescent hairline or a full head of hair, you are setting yourself up for unrealistic expectations and disappointment. The goal of hair transplantation is multifaceted. Density is without a doubt, one of the top priorities for most patients; however, other factors should also be considered.

Naturalness should be the most important factor to consider in a hair transplant. A good hair transplant clinic will give you the appearance of a natural adult hairline and naturalness throughout the mid-scalp and crown (including recreating the crown whirl).

Symmetry would be the second most important consideration – a patient with a high density frontal 1/3 and thinning mid-scalp and crown is less visually appealing than a patient with a moderately dense frontal 1/3 and good coverage in the mid-scalp and crown.

Coverage is also an important consideration and is linked with symmetry. There are limitations to how much hair can be transplanted from your donor area to the area of hair loss and the expectations should be managed both from a patient’s perspective and the hair transplant clinic. Almost any top clinic can transplant 70 FU/Cm2. Just because one can, does not mean one should. You should discuss your expectations with your hair transplant surgeon so that realistic goals are established, not only to satisfy your expectation today, but to ensure that your future goals are met as you age. Establishing reasonable expectations is very important prior to the transplantation through pre-operative consultations.

Although there is no specific minimum age requirement for a hair transplant, it is easier to determine the progression and severity of hair loss with increasing age. Typically, the younger you start to lose your hair, the worse it gets with time. For instance, if you experience significant hair loss during your 20’s, you may be able to get a hair transplant, but eventually the hair loss may become so drastic that there may not be enough hair follicles in the donor area left to finish the job as you age. This is why a younger patient should strictly adhere to the FUE procedure – as the head can be shaved in cases of more severe hair loss in the future.  As such, the ideal age for an FUT/STRIP hair transplant is the mid 30’s to late 40’s. If you want to determine how your hair loss will progress, take a look at your father and uncles and/or grandfathers on both paternal and maternal sides – assume that their most severe hair loss will resemble yours at their age. It is better to be conservative rather than too optimistic, and to wait if you are unsure about how your hair loss will progress.

Ideal candidates for hair transplant surgery are:

• Men and women in their mid-30’s to late 40’s, who have been experiencing hair loss for many years and who’s hair loss pattern has stabilized. If you are in your 20s and are severely impacted by the hair loss from a quality of life point of view, then this should be discussed with the doctor.
• Men who have been losing their hair due to male pattern baldness for several years or who have progressed to a late stage 2 or above in the Norwood scale. Patients with Norwood 1 hair loss should initially consider non-surgical treatments such as 5% minoxidil (Rogaine) or low level laser therapy. Oral Finesteride may not be recommended in men of child bearing age due to potential negative side effects such as impotence.
• Men and women with realistic expectations who understand that their hair loss might continue to progress even after a hair transplant.
• Men and women who have lost hair due to traction, other trauma, or burns, or due to other cosmetic procedures such as face-lifts.

 

Other factors to consider:

• Is your hair straight or curly? When transplanted, curly or wavy hair usually looks denser and gives the impression of more hair.
• What colour is your hair? Based on the colour of your hair and how it contrasts with your skin colour, it may give the appearance of a fuller, more natural hairline (e.g. the hairline of a Caucasian individual with light hair may look fuller than the hairline of a Caucasian individual with dark hair).
• How much hair do you have in your donor area? The amount of hair that can be transplanted depends on the amount you have available at the back of your scalp, in your donor area.

Individuals with certain types of scarring alopecia, autoimmune disease, telogen effluvium, trichotillomania, or body dysmorphic disorder, are generally not considered good candidates for hair transplantation.

In order to determine if a hair transplant is right for you, please consult a hair transplant surgeon for an in-depth consultation and evaluation.

 

References

1. Avram, MR. 2012. Hair Transplantation. Cutis; 90(6):317-20.

2. Rose, PT. 2012. Hair restoration surgery: challenges and solutions. Clin Cosmet Investig Dermatol; 8: 361–370.

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Oral tofacitinib for combined treatment of psoriasis and hair loss caused by alopecia universalis

Alopecia areata is a special form of hair loss with an autoimmune basis, with alopecia universalis being a more severe presentation of this condition. Most of the clients seen at Sure Hair have male- or female- pattern hair loss known as androgenetic alopecia.

A recent case study by Craiglow and King demonstrate the use of tofacitinib to reverse hair loss in a patient suffering from plaque psoriasis and alopecia universalis (1). Tofacitinib (Xeljanz®) was United States Food and Drug Administration (US FDA) approved in 2012 for the treatment of rheumatoid arthritis (2). However, several studies have demonstrated the safety and efficacy of tofacitinib oral and topical formulations for the treatment of plaque psoriasis (3–5). Tofacitinib works by inhibiting the activation of inflammatory signaling pathways that are seen in autoimmune diseases such as psoriasis and alopecia (6).

The patient in this case study had a history of patchy hair loss on the scalp known as alopecia areata, which began during childhood. This hair loss slowly progressed from hair loss on the scalp to hair loss on the entire body by age 18. Full body hair loss is known as alopecia universalis and includes hair loss of eyebrows and eyelashes. A few years after the loss of all hair, the patient began to exhibit symptoms of psoriasis, which progressed to cover a significant portion of his body. Treatment with adalimumab was able to clear the psoriasis for a period of time, however the psoriasis persisted. The patient wanted to try something new to combat his autoimmune diseases since adalimumab was not enough. Therefore, he looked at off-label treatment with a drug approved for arthritis; tofacitinib. Before treatment with tofacitinib the patient had no hair on his scalp, face (including eyebrows and eyelashes), arms, legs, torso, armpits, or groin. He also had several large psoriatic scaly plaques that were pink-red in coloration on his scalp, torso and elbows.

The patient took tofacitinib 5 mg twice a day to treat symptoms of both psoriasis and alopecia universalis. Partial regrowth of hair on the scalp was seen as early as 2 months after treatment began. His dosage was then increased to 15 mg daily, which led to complete regrowth of the scalp hair after 3 months. Furthermore, hair began to grow back on the face, groin region and armpits as well. After 8 months of treatment the patient had full regrowth of all body hair. Although some symptoms of psoriasis remained, the patient was so pleased with the regrowth of hair that he remains on tofacitinib. The dosage level of 15 mg of tofacitinib daily was well tolerated, however further clinical trial testing would need to be done to test the safety and efficacy of tofacitinib for treatment of combined psoriasis with alopecia. There are currently 3 clinical trials underway to study the efficacy of tofacitinib in moderate to severe alopecia areata and its variants (NCT02299297, NCT02197455, NCT02312882).

If you are experiencing patchy hair loss or hair loss on several body parts consult your doctor to determine the best treatment regimen for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

1. Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014 Dec;134(12):2988–90.
2. Xeljanz (package insert). New York: Pfizer, 2012. Available from: http://labeling.pfizer.com/ShowLabeling.aspx?id=959.
3. Boy MG, Wang C, Wilkinson BE, Chow VF-S, Clucas AT, Krueger JG, et al. Double-blind, placebo-controlled, dose-escalation study to evaluate the pharmacologic effect of CP-690,550 in patients with psoriasis. J Invest Dermatol. 2009 Sep;129(9):2299–302.
4. Papp KA, Menter A, Strober B, Langley RG, Buonanno M, Wolk R, et al. Efficacy and safety of tofacitinib, an oral Janus kinase inhibitor, in the treatment of psoriasis: a Phase 2b randomized placebo-controlled dose-ranging study. Br J Dermatol. 2012 Sep;167(3):668–77.
5. Ports WC, Khan S, Lan S, Lamba M, Bolduc C, Bissonnette R, et al. A randomized phase 2a efficacy and safety trial of the topical Janus kinase inhibitor tofacitinib in the treatment of chronic plaque psoriasis. Br J Dermatol. 2013 Jul;169(1):137–45.
6. O’shea JJ. Targeting the Jak/STAT pathway for immunosuppression. Ann Rheum Dis. 2004 Nov;63 Suppl 2:ii67–71.

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Hirsutism: Strategies for unwanted female hair growth

At Sure Hair International we are involved in helping clients regrow their hair. In this blog we will look at the opposite situation: how to deal with unwanted female hair growth.

Hirsutism is the appearance of male-patterned hair growth such as beards as well as chest and back hair in females. It affects between 5 – 15% of women, and in most cases is believed to be the result of higher-than-normal levels of male hormones referred to as androgens (1–4). This is why it is important for hirsuate women to seek professional consultation, as there may be additional underlying issues. Nonetheless there are a variety of treatment options available and a recent article has analyzed both the efficacy and potential for side-effects of each. Use of drugs to suppress or block the excess androgens as well as very low calorie diets were among the therapies investigated.

Oral Contraceptive Pills

As a method of hormone suppression, oral contraceptives are used in mild cases as a first-line treatment, and may be combined with  androgen blockers after 6 months if required (5,6). Multiple types of oral contraceptives were evaluated and were found to be equally effective (7).  Combining oral contraceptives with additional therapies such as cyproterone acetate was believed to boost results versus oral contraceptives alone (7).

Flutamide and Spironolactone

Flutamide and spironolactone are examples of androgen blockers and are generally used in more severe cases. Flutamide and spironolactone treatment were shown to produce similar results (7). Use of flutamide led to reports of breast tenderness and dry skin while some spironolactone-users  reported irregular bleeding (7).

Finasteride and Gonadotropin-Releasing Analogues   

Finasteride and gonadotropin-releasing analogues are more examples of drugs designed to block or suppress the actions of the unwanted androgens. They were both shown to have some success for this purpose but results were inconsistent (7). Finasteride use resulted in reports of breast tenderness and dry skin while hot flushes and headaches were related to gonadotropin-releasing analogue use (7).

Very Low Calorie Diets

As weight and insulin sensitivity can be linked to hirsutism, very low calorie diets were investigated but did not improve the condition (7). They did however lower body mass index (BMI)(7).

Cosmetic Procedures

Cosmetic procedures such as waxing, shaving, bleaching and chemical depilation can be useful for removing previously established hair until treatment has taken effect.  More permanent options such as electrology (electrolysis) or laser hair removal are sometimes recommended for any growth still present after 6-12 months of hormone therapy (8).

Overall, multiple methods for treatment are available. Depending on the severity of the disease, a specialist can help determine the best option for each individual case, or even combine several strategies for faster, more effective results.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961 Nov;21:1440–7.
2. Mcknight E. THE PREVALENCE OF “HIRSUTISM” IN YOUNG WOMEN. Lancet Lond Engl. 1964 Feb 22;1(7330):410–3.
3. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int J Obes. 1979;3(1):57–73.
4. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998 Sep;83(9):3078–82.
5. Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008 Apr;93(4):1105–20.
6. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al., Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565–92.
7. Van Zuuren EJ, Fedorowicz Z. Interventions for Hirsutism. JAMA. 2015 Nov 3;314(17):1863–4.
8. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995–1007.

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More hair, nice skin: ketoconazole for skin infections

This is part two of “More hair, less dandruff: ketoconazole and hair loss.” Tinea versicolor and seborrheic dermatitis are common infections of the skin caused by yeast normally found on skin. Patients with tinea versicolor exhibit round scaly lesions which may be lighter or darker than natural skin tone on their face, neck, upper arms or torso (1,2). Patients with seborrheic dermatitis have inflamed skin resulting in red patches or greasy scales on the scalp, face, torso, or groin (3). Malassezia are the species of yeast that cause these skin conditions and are present naturally on everyone’s skin. Overgrowth of Malassezia can be caused by oily skin, and warm and humid climates, it does not mean you have poor hygiene. Although these conditions are not usually life threatening, they are highly visible, prompting patients to seek medical treatment.

Topical ketoconazole is currently United States (US) Food and Drug Administration (FDA) approved for treatment of tinea versicolor, dandruff and seborrheic dermatitis of the scalp (4). Nizoral ® is a shampoo containing 2% ketoconazole and is available over the counter for effective treatment against tinea versicolor, dandruff, and seborrheic dermatitis. Ketoconazole’s antifungal properties work by disrupting the production of ergosterol, which is required by the fungal cells to make cell membranes. Without a functioning cell membrane, the cell will die, and the infection will clear up.

Ketoconazole 2% shampoo solution is also effective at decreasing scalp irritation, itching, and discomfort when used two-three times weekly for at least a month (4). To maintain the effects, ketoconazole solutions should continue to be used, however you can decrease the number of times used per week. Always discuss treatment with your doctor to ensure a change in frequency of ketoconazole use is appropriate.

For the areas of affected skin other than the scalp, ketoconazole can be purchased as a cream or foam solution. Just like the topical shampoo, these solutions do not enter the tissue underlying the skin easily, and therefore are more safe for treating superficial mycoses (5) when compared to oral drugs. Follow the directions on the label and avoid exposure to moist areas of the skin like the nostrils, mouth, and eyelids. Keep in mind this does not mean they are risk free, there are still side effects associated with topical ketoconazole. Some of these side effects are: allergic reactions, stinging, itching, and dry skin. Remember to always consult your physician before making any changes to medication, including medicated creams, foams, and shampoos. Your physician will know what will work best for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

1. Gupta AK, Bluhm R, Summerbell R. Pityriasis versicolor. J Eur Acad Dermatol Venereol JEADV. 2002 Jan;16(1):19–33.
2. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013 Aug;31(4):455–63.
3. Shi VY, Leo M, Hassoun L, Chahal DS, Maibach HI, Sivamani RK. Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol. 2015 Nov;73(5):856–63.
4. Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953.
5. Janssen Pharmaceutica. Nizoral (Ketoconazole) 2% shampoo [Internet]. [cited 2014 Nov 11]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf

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Top 4 Concealing Products for Hair Loss

1. Toupees or wigs

Toupees or wigs (as seen in the picture) are custom made, fitted hair pieces that cover up hair loss or thinning hair.¹ They consist of natural or synthetic hair, attached to a customized membrane. They can be fixed to the wearer’s scalp either semi-permanently, using medical grade adhesives, or can be removable using special hairpiece tape or clips. A semi-permanent toupee can stay in place for weeks at a time, although the hair must be partially or completely shaved to ensure a good fit and periodic refitting must occur as the hair grows underneath.

2. Thickening fibres

These are tiny electro-statically charged microfibers that attach themselves to the hair shaft, giving the impression of thicker, fuller hair. Because the electrostatic charge on the fibres is strong, they are virtually water resistant, but can be removed by shampooing. Attaining the right “look” by using thickening fibres may take some practice; some individuals report that applying too much product does not look natural. The fibres adhere to existing hair; therefore this product is not recommended for use by those who are completely bald or have large bald patches.

3. Scalp micropigmentation

This procedure involves creating several micro-tattooed dots over the scalp to give the impression of stubble. Although the process is tedious and may need to be done in two visits, the results are often dramatic. Micropigmentation is a great option for people who have minimal hair for transplantation or cannot afford a hair transplant. This procedure can also be used to cover up a previous hair transplant scar.² It is important to remember that tattoos fade slightly with time, so touch-ups may be required every few years.

4. Masking lotion

Masking lotion can be used to tint the scalp so that it matches your individual hair colour, giving the impression of a full head of hair. Although the technology of masking lotions has improved and most lotions are waterproof, they can sometimes rub off on pillows or soft furnishings, and their masking ability can also be affected by water. As with thickening fibres, masking lotions adhere to existing hairs to give the impression of volume. As such, these lotions rely on the individual having a good amount of hair to which they can adhere.

 

Article by: Dr. M. Cernea, Mediprobe Research Inc.

 

References

1. Banka N,Bunagan MJ, Dubrule Y, and Shapiro J. 2012. Wigs and hairpieces: evaluating dermatologic issues. Dermatol Ther., 25(3):260-6.
2. Rassman WR, Pak JP, and Kim J. 2013. Scalp micropigmentation: a useful treatment for hair loss. Facial Plast Surg Clin North Am., 23(3): 497.503.

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The Vampire Treatment

The vampire treatment is not a post-Halloween inspired story, but the endearing nickname for an innovative new hair growth therapy also known as PRP (platelet-rich plasma). The fast gain in popularity of this treatment comes from its well-diversified benefits including efficacy, safety and cost.

As the name suggests, PRP is plasma, (a component of the blood,) that has been enriched for platelets. Simply, a small amount of blood (only a fraction of what would be drawn for a blood donation for example) is collected from the patient. That sample is then concentrated for its platelets which contain healing properties and an abundance of growth factors (1). Lastly, the platelets are activated and injected at the site of desired hair growth.

PRP therapy has diverse applications in hair treatment with an improvement in hair growth and thickness observed in those diagnosed with the immune condition alopecia areata (2,3), the more prevalent pattern baldness (4–8) and to increase the success of hair transplant surgery (9).

One of the main advantages of PRP is that the patient’s own blood is drawn for treatment. Therefore when executed properly by your haircare professional, opportunities for transmission of infectious disease and reported side-effects are minimal (10).  Likewise without the use of specialized drugs, the costs remain low comparatively.

Currently the technology is still new but does have FDA approval for specific uses. Use of PRP for haircare would be considered “off label,” however with all of its advantages and some further investigations into methods, PRP may soon become a popular option in haircare. Talk with your hair loss specialist for more information.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Okuda K, Kawase T, Momose M, Murata M, Saito Y, Suzuki H, et al. Platelet-rich plasma contains high levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodontally related cells in vitro. J Periodontol. 2003 Jun;74(6):849–57.
2. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690–4.
3. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2004 Apr;62(4):489–96.
4. Li ZJ, Choi H-I, Choi D-K, Sohn K-C, Im M, Seo Y-J, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012 Jul;38(7 Pt 1):1040–6.
5. Sorbellini E, Coscera T with F Rinaldi. The role of platelet rich plasma to control anagen phase: Evaluation in vitro and in vivo in hair transplant and hair treatment. Int J Trichol. 2011;3:S14–5.
6. Kang J-S, Zheng Z, Choi MJ, Lee S-H, Kim D-Y, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol JEADV. 2014 Jan;28(1):72–9.
7. Park KY, Kim HK, Kim BJ, Kim MN. Letter: Platelet-rich plasma for treating male pattern baldness. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012 Dec;38(12):2042–4.
8. Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2011 Dec;37(12):1721–9.
9. Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg. 2006 Nov;118(6):1458–66; discussion 1467.
10. Kumaran MS with Arshdeep. Platelet-rich plasma in dermatology: boon or a bane? Indian J Dermatol Venereol Leprol. 2014 Feb;80(1):5–14.

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Hair extensions and traction alopecia

Hair extensions are a popular product used to create extra hair length or volume. They may be made of human hair (up to 250 hairs) or artificial hair. There are several types that are attached to the original hair in different ways. These include clip-ins, weaves (sewn to a braided corn row), pre-bonded with adhesive (attached with heat), tape, and micro-link (attached with metal rings). Hair extensions may cause stress and pulling on the natural hair by creating friction during sleep and by adding weight when the hair is wet. Constant pulling of the hair from extensions can create traction alopecia (hair loss). This may also happen from constant tension with tight ponytails, braids, corn rows, buns, head pieces, and head coverings.^1,2 The tension may pull the hair out at the roots completely or create inflammation of the hair follicles which causes them to weaken and stop producing hair. Traction alopecia is evident when the pattern of hair loss is in the same pattern as the source of the tension.

Prevention

Many people wearing hair extensions may not be aware that they have traction alopecia.³ There is a reversible phase when removing the cause of the tension may allow hair to return to normal. If hair does not return to normal within 6-9 months after removing the source of the problem, hair loss may be permanent. If hair loss is permanent, hair transplantation may be used to restore living hair to the areas. In order to prevent traction alopecia, hair extensions should be fitted by a trained professional. Extensions should also be removed as often as possible; clip-ins removed before bed may help prevent hair loss compared to other types of extensions. If you think you may have traction alopecia, please contact your dermatologist.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Ahdout J, Mirmirani P. Weft hair extensions causing a distinctive horseshoe pattern of traction alopecia. J Am Acad Dermatol. 2012;67(6):e294-e295. doi:10.1016/j.jaad.2012.07.020.
2. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol. 2007;157(5):981-988. doi:10.1111/j.1365-2133.2007.08146.x.
3. Yang A, Iorizzo M, Vincenzi C, Tosti A. Hair extensions: a concerning cause of hair disorders. Br J Dermatol. 2009;160(1):207-209. doi:10.1111/j.1365-2133.2008.08924.x.

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Top Options for Treating Hair Loss

Medication

There are currently two FDA approved hair loss therapies on the market:

Minoxidil – available as a topical foam or solution shown to  promote hair growth (1) and can be used by both men and women.

Finasteride – an oral medication for men over the age of 18 that has been shown to increase hair counts (2). Documented side-effects of finasteride include erectile dysfunction, diminished libido and reduced ejaculation however they have been reported by only a small percentage of patients (3).

Transplant

A widely used technique whereby hair follicles are harvested from the back of the scalp and positioned in areas of hair loss, resulting in natural-looking hair growth (4). Innovations in transplant technology allow the donor area to remain virtually undetectable. Options are now available to individualize the procedure to patient’s needs including the strip method and the follicle unit extraction method.

Hair Concealers

A variety of concealing products are available as an alternative to medication or surgery. As the name suggests, these products will not restore hair loss but can conceal it effectively. Hair thickening fibers for instance are microscopic hair fibers which can be sprinkled onto target areas to cover hair thinning and loss. A great benefit to hair thickening fibers is their resistance to water, sweat and adverse weather but still wash out with normal shampooing. They can also be used in addition to medication.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed. 2015 Jun;13(3):185–9.
2. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat. 2014 Apr;25(2):156–61.
3. Perez-Mora N, Velasco C, Bermüdez F. Oral Finasteride Presents With Sexual-Unrelated Withdrawal in Long-Term Treated Androgenic Alopecia in Men. Skinmed. 2015 Jun;13(3):179–83.
4. Gho CG, Neumann HAM. Advances in Hair Transplantation: Longitudinal Partial Follicular Unit Transplantation. Curr Probl Dermatol. 2015 Feb;47:150–7.

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The Essentials of Female Hair Loss

Of recent popular discussion has been the suggestion that essential amino acids can be used to either prevent, or correct hair loss. Thus if you are looking for a natural and un-invasive remedy, essential amino acids might sound like the perfect plan. But is this treatment effective and how does it work?

Firstly, amino acids are the individual components which join together to create protein, including the protein found in hair. Our bodies are able to synthesize many of the amino acids required for our proteins but not all. The rest are supplied through diet and are referred to as the essential amino acids. Therefore it might make sense to assume that consuming more essential amino acids should equal more hair. Moreover, nutritional status has been correlated with hair loss, however in most cases adequate levels of essential amino acids are obtained through diet without the need for supplements (1). As has been discussed previously in this blog, there are many reasons for hair loss but poor nutrition on its own does not seem to be a common diagnosis. Although there does seem to be at least one documented exception.

An increased intake of the essential amino acid lysine in combination with iron has been shown to be effective for women specifically (2–4). A clinical study reported that over 70% of women noticing increased hair loss were also low in iron (2). Furthermore, menstruating women have a greater need for increased daily iron (1).

Overall, a diet that contains a moderate amount of the essential amino acid lysine as well as iron may improve hair loss in women. Try some lysine-rich choices including meat, fish and eggs as one step in maintaining your quality of hair.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002 Jul;27(5):396–404.
2. Rushton DH, Ramsay ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol. 1990 Aug;123(2):187–97.
3. Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol. 2003 Nov;121(5):985–8.
4. Rushton DH, Norris MJ, Dover R, Busuttil N. Causes of hair loss and the developments in hair rejuvenation. Int J Cosmet Sci. 2002 Feb;24(1):17–23.

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Hair loss stages

Male pattern baldness (androgenetic alopecia) is responsible for 95% of all hair loss in men. This hereditary condition is caused by the hormone dihydrotestosterone (DHT), which causes healthy hair follicles to shrink and the hairs attached to them to consequently fall out. When considering treatment (oral or topical medications) for your hair loss, it is important to establish how far your hair loss has progressed. The Norwood scale is often used by clinicians to characterize hair loss progression.

Norwood hair loss type 1

This type describes the least amount of hair loss. Consider this normal unless you have a family history of male pattern baldness. Monitor your situation to determine if your hair loss develops into stage 2.

Norwood hair loss type 2

This type describes a small amount of hair loss. There is a good chance that, with treatment, you can regain most or all your lost hair. Consult a doctor to verify that your hair loss is caused by male pattern baldness.

Norwood hair loss type 3

This type describes a small to moderate amount of hair loss. A combination therapy may be helpful if your frontal hair line is being stubborn in growing back. Hair transplantation may also be considered.

Norwood hair loss type 4

This type describes a moderate amount of hair loss. At this level, there is no guarantee that using all the treatments listed will bring back almost all your hair. At this level of hair loss, you may not restore a satisfactory amount of hair since not everyone responds favorably to these treatment options. Hair transplantation may also be considered.

 Norwood hair loss type 5

This type describes a moderate to large amount of hair loss. At this level, there is no guarantee that using all the treatments listed will bring back a large amount of hair. A hair transplant may be the best option if you want to regain most or all of your hair. Consult your doctor to discuss treatment options.

Norwood hair loss type 6

This type describes a large amount of hair loss. There is no guarantee that using oral or topical treatments will bring back a large amount of hair. At this level, a hair transplant may be the most effective option for your hair loss. Consult your doctor to discuss treatment options.

Norwood hair loss type 7

This type describes the highest amount of hair loss with the least chance of regaining a large amount of lost hair. Consult your doctor to discuss treatment options.

Treatments for male pattern baldness include Rogaine® (generic name: minoxidil) 2% or 5%,¹ Rogaine in combination with Retin-A 0.025%,² and Propecia® (generic name: finasteride).³ Where hair loss has progressed to a higher stage, these treatments will not restore a full head of hair, but allow one to climb back into a lesser stage of the Norwood scale. For example, with stage 6 hair loss, a reasonable outcome with treatment is a return to stage 4 or 5. Hair transplantation may also be considered at early-mid stages of hair loss. Consult your doctor for treatment options that are best suited to your needs.

Article by: Dr. M. Cernea, Mediprobe Research Inc.

References

1. Goren A,Shapiro J,Roberts J, McCoy J, Desai N, Zarrab Z, Pietrzak A, Lotti T. 2015. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.” Dermatol Ther 28 (1): 13–6.

2. Ferry JJ, Forbes KK, VanderLugt JT, Szpunar GJ. 1990. Influence of tretinoin on the percutaneous absorption of minoxidil from an aqueous topical solution. Clin Pharmacol Ther 47 (4): 439-46.

3.Varothai S, Bergfeld WF. 2014. Androgenetic alopecia: an evidence-based treatment update. American journal of clinical dermatology 15 (3): 217–30.

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